First-of-its-kind dual live-donor transplant surgery in the World gives 20-month old baby a second chance at life

20 February 2017

The transplant team at Aster Medcity, Kochi created history by performing a simultaneous live-donor liver and kidney transplant on baby Parvathy – a 20-month old toddler who weighs just 7 kilograms. She has become the smallest child in the world to have successfully undergone this highly complex procedure.

A native of Kodakara in Thrissur, Parvathy, the only daughter of Shinu and Saritha, was first diagnosed with a chronic kidney problem when she was just 3 months old. She had Primary Hyperoxaluria Type 1 – a very rare condition whereinthe deficiency of a liver enzyme called AGXT leads to abnormal spike in blood Oxalate levels, which in turn causes permanent kidney damage.

The only treatment option being a combined liver - kidney transplantation, she was put on an intense nutritional rehabilitation programmeto attain a pre-transplant weight of 10 kilograms, along with dialysis. She was put on peritoneal dialysis and later hemodialysis, with the support of blood pressure regulators. However, she stopped gaining weight due to multiplecomplications.

Seeingher condition worsen by the day, her doctorsdecided to go ahead with the surgery in spite of the very high risk factors. The main challenge was her weight and size as children less than 10kilograms will not have adequate space to accept an adult kidney. And if a disproportionately large kidney is transplanted, there will be compression in the kidney veins, which in turn will lead to clots in the transplanted kidney.

“The solution was to remove her damaged right kidney and use the space vacated by her liver to place the new kidney. The blood volume in her kidney too had to be increased using highly specialised perioperative anaesthetic techniques. Her father and grandmother were identified as the liver and kidney donors, respectively”, said Dr. Mathew Jacob, Consultant Liver & Abdominal Multi-Organ Transplant Surgeon.

After two weeks of extensive planning and preparations, the20-hour transplant procedure comprising three simultaneous surgeries – liver donor, kidney donor and recipient- was successfully was carried out by a team of surgeons led by Dr. Mathew Jacob, Dr. Rehan Saif, Dr. Sonal Asthana, Dr. Rajiv Lochan and D. Kishore TA and six anaesthetists led by Dr. Suresh G Nair. This is the first time in the world that a dual live-donor- liver and kidney transplant surgery has been performed in such a small child.

Post surgery, Parvathy had to stay in the hospital for 51 days. She recovered well and started gaining weight. Her pre and postoperative care was handled by Dr. Rajappan Pillai, Consultant Paediatric Intensivist.

“Parvathy’s case is testimony to that the fact that we can achieve what we think is unachievable. Our team has pushed the boundaries of possibility, challenged adversities and created history. This speaks volumes about their clinical expertise and ability to provide medical care that’s truly world-class. Put simply, for us this is one more way of living up to our simple promise: We’ll Treat You Well”, said Dr. Harish Pillai, CEO - Aster Medcity & Cluster Head (Kerala) - Aster DM Healthcare.

Parvathy was treated by 35 doctors from various sub- specialties including:

The Nephrology & Urology team led by Dr. V Narayanan Unni The Hepatology team led by Dr. Naveen Ganjoo & Dr Charls Panackal The Paediatrics team Dr. P C Alexander The Paediatric Gastroenterology team led by Dr. Geetha Mammayil